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Quick Notes for Step 1 > GI > Flashcards

GI Flashcards

1
Q

Secretin

A

Produced by Duodenal S-endocrine cells → increases bicarb secretion from pancreas into small bowel

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2
Q

Risks of TPN (total parenteral nutrition)

A

Increased risk of gallstones as result of biliary stasis from decreased CCK due to absent enteral stimulation

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3
Q

Zenker Diverticulum Caused by _____

A

Cricopharyngeal motor dysfunction → increased pressure

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4
Q

Meckel Diverticulum is a remnant of ______ vs Cyst/Fistula from Bladder is from _________

A
  • Yolk Sac (vitelline duct)

- Allantois (urachus)

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5
Q

Lesser Omentum

A

On lesser curvature and is made up of hepatoduodenal (portal vein, hepatic artery, common bile duct) and hepatogastric ligaments

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6
Q

Globus Hystericus

A

“Lump in throat”, fairly common, triggered by emotions

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7
Q

Effect of Portal HTN on Splenic Vein

A

Portal hypertension in cirrhosis → splenic vein hypertension and splenomegaly (due to venous accumulation) → congestion of blood in spleen → apparent red pulp expansion

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8
Q

Ischemic Colitis

A

Mucosal hemorrhage and patchy

- Aw/ severe atherosclerosis (may have weak lower extremity pulses)

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9
Q

Effect of Bile Acids on Microbes

A

Bile acids can emulsify the membranes of microbes in gut (may have bacterial overgrowth without them)

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10
Q

Crohn’s MC in:

A

Terminal Ileum

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11
Q

Lactulose

A

Treats hepatic encephalopathy by acidifying GI tract contents

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12
Q

Ethylene Glycol Poisoning

A

Sudden onset back pain, hematuria, and oliguria w/ high anion gap metabolic acidosis
- Calcium oxalate crystals in urine

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13
Q

Brunner’s glands, Crypts of Leiberkuhn, and Goblet Cells

A
  • In submucosa of the duodenum secrete alkaline fluid
  • Crypts of Leiberkuhn deliver secretions and where stem cells reside
  • Goblet cells make mucus
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14
Q

OATP

A

Liver takes up unconjugated bilirubin passively through OATP (organic anion transporting polypeptide)
- MOAT is to transport out conjugated bili (active transport)

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15
Q

Fitz-Hugh-Curtis

A

Neisseria Gonorrhea, violin string adhesions to liver

- Different from Waterhouse Friedrichson (Neisseria meningitidis, hemorrhaging adrenal crisis)

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16
Q

7-a-Hydroxylase

A

Converts cholesterol to bile acids

- Inhibited by fibrates → excess cholesterol in bile → cholesterol gall stones

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17
Q

Main Site of Lipid Absorption

A

Jejunum

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18
Q

Damage to Hepatocytes in HepB due to:

A

CD8 mediated damage to infected hepatocytes due to presence of the virus causes (HepB does not have cytotoxic effect)

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19
Q

Window Period for HepB

A

HBsAg and HBsAb are both undetectable

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20
Q

Intussusception

A

MC bowel obstruction from 3mo-6yrs (peak b/w 5-10mo)→ currant jelly stools
- telescoping bowel

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21
Q

Congenital pyloric stenosis

A

3-4 week old w/ projectile vomiting and olive mass in abdomen

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22
Q

Ascaris Lumbricoides

A
  • High pitched tinkly/steel drum bowel sounds
  • Can cause Type 1 hypersensitivity
  • Most potent allergen
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23
Q 
Stool Findings for:
Strongyloides roundworm
Tapeworms
Protazoa (Giardia, Histolytica)
Schistosomiasis
A
  • Strongyloides roundworm: rhabditiform larvae in stool
  • Tapeworms: proglottids
  • Protazoa (giardia, histolytica): trophozoites and cysts
  • Schistosomiasis: eggs
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24
Q

Risk of Using Fibrates and Bile-Acid Binding Resins Together

A

Gallstones

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25
Q

Bile Acid Binding Resins (cholestyramine)

A
  • Side effects: increased triglycerides and cholesterol gallstones
  • Often used with statins, but should be taken at least 4 hours apart because it decreases statin absorption
  • also increase hepatic cholesterol synthesis
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26
Q

Menetrier’s Disease

A

Protein losing enteropathy due to excess mucus production (mucin cell hyperplasia)
- commonly in elderly

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27
Q

Villous Adenomas

A
  • Can secrete large amounts of mucus → secretory diarrhea
  • Can be cauliflower like shaped projections
  • Risk of colorectal cancer
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28
Q

Esophageal Varices

A

Portal HTN → anastomosis of left gastric (portal) with esophageal veins (caval system)

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29
Q

Caput Medusa

A

anastomosis of paraumbilical veins (portal) with superficial abdominal veins

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30
Q

Internal Hemorrhoids

A

anastomosis of superior rectal veins (portal) with inferior rectal veins

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31
Q

HNPCC

A

(Lynch Syndrome)
MLH1 and MSH2 gene mutations
- mismatch repair problem

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32
Q

Fulminant Liver Failure in Pregnant Women

A

HepE

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33
Q

Hep B

A
  • usually sexually transmitted

- integrates into genome

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34
Q

Hep C

A
  • usually IV drug abuse

- RNA w/o reverse transcriptase so cannot integrate into genome

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35
Q

Hep A

A
  • fecal oral

- dark urine due to increased serum bilirubin

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36
Q

Plummer Vinson Triad

A

atrophic glossitis, iron deficiency, esophageal webs

- also increased risk squamous cell carcinoma

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37
Q

ETEC

A
  • traveler’s diarrhea

- LT enterotoxin is a cholera-like toxin

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38
Q

Air in Biliary Tree

A

Fistula between gall bladder and bowel allows stone into gut and it will get stuck at ileocecal valve (gallstone ileus)

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39
Q

Upper Glandular Gastric Layer

A

Parietal Cells (secrete acid)

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40
Q

Deep Glandular Gastric Layer

A

Chief Cells (secrete pepsinogen)

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41
Q

Hepatoduodenal Ligament

A

portal vein, hepatic artery, and common bile duct

42
Q

Systemic Mastocytosis

A

clinical signs of too much histamine (flushing, itching, etc) and increased gastric acid production due to the increased histamine

43
Q

Imperforate Anus

A
  • commonly found with other genitourinary abnormalities

- Also VACTERL (vertebral, anal atresia, tracheoesophageal fistula, esophageal atresia, renal and limb abnormalities

44
Q

Abetalipoproteinemia

A

Fat accumulation at the tips of villi in the intestine because the fat cannot be put into the blood (it just accumulates in enterocytes)
- Will see acanthocytes in blood

45
Q

Polyethylene Glycol

A

osmotic laxative (similar mechanism to lactase deficiency)

46
Q

Motion Sickness Prevention

A

Antimuscarinics and antihistamines w/ antimuscarinic activity are most effective

47
Q

Intergluteal Pilonidal Disease

A

acquired skin infection involing upper natal cleft of the buttocks, may present with draining sinus tracts

48
Q

Volvulus

A

Midgut rotation around SMA failure

49
Q

HepB Infected Hepatocyte Destruction

A

Host CD8 cytotoxic T cells kill hepatocytes because their cell surface presents hep B antigens

50
Q

Hemorrhage due to Ulcer

A
  • Lesser curvature: left gastric

- Posterior duodenum: gastroduodenal

51
Q

Diphenoxylate and Loperamide

A
  • used as antidiarrheal by decreasing motility
  • Acts at mu receptors (opioid) in GI tract
  • Higher doses → euphoria and physical dependence
  • Combine with atropine to prevent abuse
52
Q

Signet Ring Cells

A

Diffuse Gastric Adenocarcinoma (mucus in cell pushes nucleus to side)

53
Q

Acute Pancreatitis

A

Usually gallstones or alcohol, but can be from hypertriglyceridemia

54
Q

SPINK1

A

Pancreatic trypsin inhibitor (prevents autodigestion of pancreas)

55
Q

Mallory Weiss: metabolic effect

A

repetitive vomiting → metabolic alkalosis from vomiting up gastric acid

56
Q

Fidoxamicin

A

(oral) for C. Diff has minimal systemic absorption and is bactericidal
(Vanco and metronidazole are bacteriostatic)

57
Q

Lactase Deficiency

A

Increased stool osmolarity
Decreased stool pH, and Increased breath hydrogen
- lactase gene expression decreases/downregulated with age

58
Q

Crohn’s vs UC: T cells

A

Crohn’s: TH1 mediated (non-caseating granulomas)

UC: TH2 mediated

59
Q

Sporadic Colorectal Cancer mutations

A

APC → K-RAS → p53 & DCC

60
Q

Arsenic or Polyvinyl Chloride

A

Liver hemangiosarcoma

- Arsenic poisoning should be treated with Dimercaprol

61
Q

Whipple’s Disease

A
  • T. Whippelii
  • Foamy large macrophages filled with PAS+ granules and bacilli in small intestine mucosa
  • Malabsorptive diarrhea and arthropathy
62
Q

Salmonella Typhi

A
  • typhoid fever
  • travel followed by watery diarrhea that becomes blood (due to bowel perforation)
  • salmon colored spotty rash on torso
63
Q

Curling Ulcers

A

In burn patients

64
Q

Cushing Ulcers

A

Related to head trauma

65
Q

CYP 450 found in Zone

A

Zone 3

66
Q

Peyers patches and largest number of goblet cells found in ____

A

Ileum

67
Q

Intestinal Atresia

A

Apple peel atresia due to vascular accident

68
Q

Above Pectinate Line

A
  • Super rectal artery (of IMA)
  • Superior rectal vein (to IMV – portal)
  • Not painful (visceral innervation)
  • Lymph drains to deep nodes
69
Q

Below Pectinate Line

A
  • Inferior and middle rectal artery (of pudendal artery)
  • Inferior rectal vein (to internal pudendal → internal iliac → IVC – non-portal)
  • Painful (somatic innervation, inf rectal branch of pudendal)
  • Lymph drains to superficial inguinal nodes
70
Q

Very low infectious inoculation

A

Giardia, Entaemoba, Shigella, and Campylobacter

71
Q

Excess copper mainly excreted by:

A

hepatic excretion into bile, and partly through urine

72
Q

D-xylose

A
  • monosaccharide (doesn’t need action of pancreatic enzymes to be absorbed)
  • Used to test for malabsorption
73
Q

Ulcer Location: Zollinger Ellison vs Peptic Ulcer Disease

A
  • Zollinger Ellison: distal duodenum

- Peptic ulcer disease: proximal duodenum or lesser curvature of stomach

74
Q

Portal Vein Thrombosis vs Budd Chiari

A
  • Portal vein thrombosis does not cause any histologic changes to liver –> portal HTN
  • Budd-Chiari (blocks hepatic vein) would have centrilobular congestion w/ portal HTN
75
Q

Meconium Ileus

A

due to dehydrated mass of meconium blocking ileocecal valve caused by Cystic Fibrosis

76
Q

Non-neoplastic GI polyps

A

Hamartomatous, Hyperplastic, and Inflammatory

- no risk of transforming into cancer (unlike adenomatous polyps)

77
Q

Pancreas: Ventral Bud

A

Main pancreatic duct (part), inferior and posterior part of the head, and the uncinate process

78
Q

Pancreas: Dorsal Bud

A

Main pancreatic duct, body, tail, and most of the head

79
Q

Left Sided Colon Cancer

A

Obstructive (infiltration of intestinal wall encircling the lumen) –> change in stool caliber, constipation, cramping pain, abdominal distension, nausea, and vomiting

80
Q

Ride Sided Colon Cancer

A

Exophytic mass that does not develop obstruction (right side is larger)
- iron deficiency anemia due to ongoing blood loss, anorexia, weight loss, fatigue

81
Q

PPIs

A

Block final common pathway of gastic acid secretion from parietal cells (so no effect with Ach via vagus, histamine, or gastrin)
- Histamine blockers only block the Histamine receptors and M3 blockers will only block the vagus effect

82
Q

Diffuse Esophageal Spasms can mimic

A

Angina Pectoralis

83
Q

Middle aged women w/ long history of pruritis and fatigue presenting w/ pale stool and xanthelasma

A

Primary Biliary Cirrhosis (PBC)

84
Q

Male with long history of UC w/ fatigue and high alkaline phostphatase

A

Primary Sclerosing Cholangitis (PSC)

85
Q

Pancreatic Pseudocyst

A

MC occurs after acute appendicitis

-Round fluid filled space in parenchyma of pancreas (90% in tail)

86
Q

Fibrosis between Nodules

A

Cirrhosis

Regenerative nodules are made up of proliferating hepatocytes

87
Q

Cryptosporidium in AIDS

A

Chronic watery diarrhea

88
Q

High Estrogen in Cirrhosis

A

Spider angiomas, gynecomastia, testicular atrophy, decreased body hair, palmar erythema, and Dupuytren’s contractures

89
Q

“Crypt abscesses”

A

Seen with Ulcerative Colitis (UC)
- neutrophils accumulate in crypt lumina
erythematous, friable granular mucosa

90
Q

Kayser Fleischer Rings

A
  • aw/ Wilsons Disease

- Brownish or gray-green rings of fine granular copper deposits in Descemets membrane of the Cornea

91
Q

H. Pylori Gastric Ulcer

A

H. pylori produces proteases and particularly urease, which allow it to decrease the pH of the its local environment by cleaving urea into ammonia, which is toxic to gastric mucosa

92
Q

Killing C. Difficile Spores

A
  • Handwashing with soap is necessary
  • Equipment should be autoclaved (steam) to clean it
  • Alcohol-based rubs are not sufficient to kill the spores
93
Q

Fluid in Lesser Sac

A

Fluid is contained in a space behind the stomach but in front of the retroperitoneal structures (e.g. the pancreas)

94
Q

TIPs Procedure

A

Surgical portosystemic shunts to decrease Portal HTN

  • MC is creating an intrahepatic shunt between the portal and hepatic veins
  • can also anastomose the splenic vein to the nearby left renal vein
95
Q

Gall bladder cannot be visualized on a radionuclide biliary scan

A

Acute Cholecystitis w/ gallstone obstruction of cystic duct

96
Q

Chronic Mesenteric Ischemia

A

“intestinal angina”
Atherosclerosis of mesenteric arteries causing diminished blood flow to intestine after meals –> post-prandial epigastric pain
- aw/ food aversion and weight loss

97
Q

Non-infective envelop glycoprotein that forms spheres and tubules 22 nm in diameter

A

HBsAg

usually secretes in huge quantities

98
Q

Nucleocapsid core and pre-core protein that is a marker of high infectivity

A

HBeAg

99
Q

For Hepatitis D virus to infect:

A

the HBsAg of HepB must coat the HDAg of hepatitis D before it can infect hepatocytes and multiply

100
Q

Most Dangerous Complication of UC

A 
Toxic megacolon (can lead to perforation)
Do not do barium enema or colonoscopy
Can do an X-ray
101
Q

Crohns: Oxalate Kidney Stones

A

Impaired bile acid absorption –> subsequent fat malabsorption –>lipids bind calcium ions and the soap complex is excreted –> free oxalate absorbed
- the oxalate is normally bound by calcium in the intestine so it gets excreted

102
Q

Vagus on G cells

A

Releases GRP

Quick Notes for Step 1 (18 decks)

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